Flex

Dependent Care Flexible Spending Account (FSA) Worksheet

This worksheet can help you decide if you would benefit more from the Federal Child Care tax credit or from a Dependent Care FSA. It can also be used to determine an appropriate Dependent Care FSA election. For detailed tax rate information, consult your tax advisor.

Estimate Your Monthly Dependent Care Expenses

Infant/Toddler

$

Preschool (Kindergarten and above is not eligible)

$

Before and after school care

$

School Vacations/Holidays

$

Other Dependent care

$

Total MONTHLY Expenses

$

Total ANNUAL Expenses

$

Maximum Non-Taxable Expenses

$ 5,000.00

Annual household income

$

Number of children you claim on taxes

Number of qualifying dependents

Tax filing status

Married and Filing Jointly Married and Filing Seperately Head of Household Single

State in which you live

Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Estimated Annual Taxable Income

$ 0.00

Dependent Care FSA

* Estimated election or maximum allowed

$ 0.00

Additional amount you may take as Child Care Tax Credit

$ 0.00

Estimated Annual Tax Savings

$ 0.00

FEDERAL CHILD CARE TAX CREDIT

* Maximum you may include on taxes

$ 0.00

Estimated Annual Tax Savings

$ 0.00

* If your spouse earns less than this amount, or if your spouse is a full-time student or is disabled, please contact Allegiance for help in determining maximum election allowed.

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